Another Lightwalker laser one-piece e.Max crown removal

Charles Lo Giudice

8 years ago

Sometime this past summer, I can't remember exactly when,  one of our faculty showed a case and commented on the difficulty of removing an e.Max crown by sectioning it with a bur.  People comment from time to time about how it is often necessary to prep e.Max crowns off because the bonding resins we use provide such a strong bond.  I fractured the tooth with one of the first ones I tried to remove because I did not section it into enough pieces.  Then, an article in Dentistry Today, a "throw away journal" as we are fond of calling some of the periodicals we get in the mail, changed my life--a slight over statement there.  Dr. Jeffrey Cranska presented his protocol for debonding e.Max crowns using his Fotona Powerlase, removing the restorations in one piece.  I tried it the next time I had to remove a bonded ceramic crown, and it works!  3 to 5 minutes bathing a crown in ErYAG laser energy certainly beats 15 to 20 minutes (or more) sectioning and chipping away a ceramic crown.  Admittedly, the investment in the laser and the necessary training requires more justification than removing ceramic crowns in one piece.  I use mine for endodontic irrigation, perio (including frenectomies, ginvgivectomies, and I have even done a couple of torus removals), and preparing small carious lesions.  90% of my pedo is done with my Lightwalker laser and no anesthetic, and adult patients are more than tickled pink when they walk out of my office after receiving a "filling" and they are not numb at all.  This case is one of my failures--an open distal margin on a #14 Celtra Duo crown.  My conscience wouldn't let me kick this can down the road and when the crown was removed, decay was found on the distal axial wall of the preparation.  This case was done as warranty work, as I call it.  Don't ask me why the replacement crown is e.Max.  There was nothing wrong with the Celtra Duo crown other than the open margin, which was not the fault of the material.  I did remove that bonding resin under the distal contact before the patient was dismissed.  PS  Fotona gave me a list of 20 CEREC docs, all of whom are on this forum, including Skrammy, and they want me to try to try to sell a few machines.  I told them that my chances of doing that are slim and none.